December 11, 2014:  For many years, we have reported on trends in employment, education and demographic characteristics of the registered nurse (RN) workforce in the United States. For the most part, data we analyze originates from three federal surveys: the National Sample Survey of Registered Nurses (NSSRN), the Current Population Survey (CPS), and the American Community Survey (ACS). Using data from these surveys, we have identified and analyzed trends related to age, gender, wages, race and ethnicity, educational preparation, full- and part-time employment, and other characteristics of the RN workforce across both hospital and non-hospital settings. While extremely valuable, one drawback to using these data sets is that it takes a period of time before data from these surveys are made available to the public. For example, the NSSRN (which was discontinued after 2008) and the ACS become available roughly a year after the survey was conducted. In contrast, the CPS is administered on a monthly basis. Yet due to its smaller sample size, our practice has been to wait until roughly February 2014, for example, when all the surveys from 2013 were combined and released together. Consequently, by the time our team was able to report trends in peer-reviewed journal articles, many of the trends were already one or even two years out of date.

Yet for some labor market outcomes, we have confirmed that reporting data from the CPS at three-month (rather than annual) intervals provides informative estimates. The data for January-March, for example, are available to researchers in April. Thus, in the interest of providing more timely data on the RN workforce, we will be reporting certain RN workforce data on a quarterly basis on the Center’s website.

This quarterly data is compiled using the CPS basic monthly files, which are released with roughly a one-month delay. These data contain basic demographic and labor force variables for all respondents, as well as wage and hourly data for a portion of the respondents. Quarterly statistics are reported as an average of the three months’ values; trends are estimated using a time-series filter to remove cycles up to two years in a period.

New Quarterly Data Show Dynamic Changes in RN Employment. Using data from the Current Population Survey’s Basic Monthly files, the nearby Figure shows FTE RN employment on a quarterly basis in hospitals and non-hospital settings from 2005 through the 3rd quarter of 2014.

Quarterly_hospvNHosp

The Great Recession and Increased Hospital Employment. Starting in 2005, the number of RNs employed on an full-time equivalent (FTE) basis increased at a gradual pace over the next several years in both hospital and non-hospital settings. However, when the Great Recession officially began during the 4th quarter of 2007, employment in hospitals shot up suddenly. Although we expected an increase in RN employment as the recession began[1], the size of this increase was beyond our expectation.

RN Employment in Non-Hospital Settings Reaches a Milestone.  Following this increase in hospital RN employment, RN FTE employment in both settings increased at a very gradual pace through the 3rd quarter of 2011. Thereafter, RN employment trends changed as employment in non-hospital settings increased substantially though the end of 2012. Consequently, the percentage of RNs working in hospitals slipped, for the first time, below 60%, a trend reported on the Center’s website here. At the time we spotted these changes, we wondered whether this expansion in non-hospital employment was associated with the implementation of delivery reforms under the Affordable Care Act that seek to shift care away from high-intensity, acute-care settings. At the same time, we also noticed that a large portion of this increased employment in non-hospital settings was among RNs over the age of 50, and a non-trivial amount (roughly 60,000) from younger RNs (under 35).

And Yet Another Change.  This very large increase in FTE RN employment in non-hospital settings was short-lived. From an all-time employment high of 1,237,000 FTE RNs working in non-hospital settings at the end of the 1st quarter of 2013, the number fell back over the next two years to levels approaching those of the mid-2000s.   Over the same period, hospital RN employment skyrocketed, reaching nearly 1,870,000 at the start of 2014, before falling back over the 2nd and 3rd quarters of 2014.

The data shown in the Figure suggest several trends:

  1. Employment of RNs is dynamic: Swings in employment have been very large, several times exceeding 100,000 FTEs. These swings have occurred over a short period of time, as little as one quarter
  1. These employment swings have occurred in both hospital and in non-hospital settings
  1. They often occur at the same time, but in opposite directions
  1. Net employment in non-hospital settings over the past 39 quarters has increased by 133,295 (13%)
  1. Net employment in hospital settings over the past 39 quarters has increased by 492,000 (28%), with most of that growth occurring in two waves: the first during the recession in 2007 and 2008, and the second during the past 5 quarters

Recent Trends in the Age of Full-time Employed Registered Nurses: Younger RNs on the Rise. Using data from the Current Population Survey’s Basic Monthly files, the below Figure shows the number of FTE RNs broken down by age categories on a quarterly basis from 2005 through the 3rd quarter of 2014.

Quarterly_age_fte

Nearly ten years ago, in 2005, RNs between the ages of 35 and 49 dominated the workforce. Since that time, the number of FTE RNs in that age range has continued to hover around 1 million. The next largest age group of FTE RNs, those over age 50, have grown in number over this period as the baby boomers have aged, matching the 35-49 age group in size by 2011. The fastest growing group of FTE RNs over the past 10 years has been younger aged nurses, however. Starting at around 450,000 FTEs in 2005, the number of FTE RNs less than 35 has grown rapidly and steadily, doubling in size from 2005 to 2014.

The aging of the workforce due to the baby boomer RNs has been known and forecasted more than a decade ago (although many are retiring later than expected).[2] However, the rapid growth of younger aged RNs was not expected a decade ago, and exerts an important effect on our projections of the future supply of RNs through 2030.[3][4] In preliminary analysis (not reported here) that assumes RNs will continue to enter nursing in the future in roughly the same numbers as they have done over the past several years, this entry into nursing could increase the future supply of RNs substantially, perhaps even enough to replace all the RNs who will retire over the next 10 to 15 years. These projections critically depend on the trajectory of future entry into the workforce, which is why tracking younger RNs is key to this effort. Stay tuned for further information on our latest projections of the future supply of RNs.

Center for Interdisciplinary Health Workforce Studies, Quarterly Update No. 1
December 2014
Peter Buerhaus, David Auerbach, Douglas Staiger, and Christine Friedman

Footnotes:

[1] Previous work found that RNs tend to increase their workforce participation during recessions – possibly due to uncertainty in their spouses’ employment outlook. See Buerhaus, P. & Auerbach, D. (2011), The Recession’s Effect on hospital registered nurse employment growth. Nursing Economic$. 29(4):4 163-167; Staiger DO, Auerbach DI, and Buerhaus, PI, and “Registered Nurse Labor Supply and the Recession: Are We Currently in a Bubble?” New Engl J Med, March 21, 2012.

[2] Buerhaus, PI, Staiger DO, andAuerbach, DI. “Implications of a rapidly aging registered nurse workforce,” Journal of The American Medical Association (JAMA), 238 (22), June 14, 2000;

[3] Auerbach, D., Buerhaus, P., Staiger, D. (2011). Surge in those ages 23-26 entering the registered nurse work force means that supply is growing faster than projected. Health Affairs. 30, 12: 2286-2292.

[4]Auerbach, DI., Buerhaus, PI, and Staiger, DO. “Registered Nurses Are Delaying Retirement, A Shift That Has Contributed To Recent Growth In The Nurse Workforce.” Health Affairs (2014): 10-1377.